scholarly journals In-hospital and mid-term outcomes in patients reoperated on due to bleeding following coronary artery surgery (from the KROK Registry)

2019 ◽  
Vol 29 (2) ◽  
pp. 237-243 ◽  
Author(s):  
Piotr Knapik ◽  
Małgorzata Knapik ◽  
Michał O Zembala ◽  
Piotr Przybyłowski ◽  
Paweł Nadziakiewicz ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Postoperative Complications ◽  
Hospital Mortality ◽  
Hospital Discharge ◽  
Postoperative Bleeding ◽  
Low Risk ◽  
Coronary Surgery ◽  
Coronary Artery Surgery ◽  
Starting Point ◽  
Risk Patients

Abstract OBJECTIVES Surgical re-exploration due to postoperative bleeding that follows coronary artery surgery is associated with significant morbidity and mortality. The aim of this study was to assess a relationship between re-exploration, major postoperative complications, in-hospital mortality and mid-term outcomes in patients following coronary surgery, on the basis of nationwide registry data. METHODS We identified all consecutive patients enrolled in Polish National Registry of Cardiac Surgical Procedures (KROK Registry) who underwent isolated coronary surgery between January 2012 and December 2014. Preoperative data, major postoperative complications, hospital mortality and mid-term all-cause mortality were, respectively, analysed. Comparisons were performed in all patients, low-risk patients (EuroSCORE II < 2%, males, aged 60–70 years) and propensity-matched patients. The starting point for follow-up was the date of hospital discharge. RESULTS Among 41 353 analysed patients, 1406 (3.4%) underwent re-exploration. Reoperated patients had more comorbidities, more frequent major postoperative complications, higher in-hospital mortality (13.2% vs 1.8%, P < 0.001) and higher mid-term mortality in survivors (P < 0.001). In the low-risk population, 3.0% of patients underwent re-exploration. Reoperated low-risk patients and propensity-matched patients also had more frequent major postoperative complications and higher in-hospital mortality, but mid-term mortality in survivors was similar. In a multivariable analysis, re-exploration was an independent predictor of death and all major postoperative complications. CONCLUSIONS Surgical re-exploration due to postoperative bleeding following coronary artery surgery carries a high risk of perioperative mortality and is linked to major postoperative complications. Among patients who survive to hospital discharge, mid-term mortality is associated primarily with preoperative comorbidities.

scholarly journals Coronary artery surgery in women compared with men: analysis of coronary risk factors and in-hospital mortality in a single centre.

Heart ◽  
1994 ◽  
Vol 71 (5) ◽  
pp. 408-412 ◽  
Author(s):  
M. Barbir ◽  
F. Lazem ◽  
C. Ilsley ◽  
A. Mitchell ◽  
A. Khaghani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Coronary Risk Factors ◽  
Coronary Risk ◽  
Single Centre ◽  
Coronary Artery Surgery

Abstract 137: Efficacy and Cost Savings Realized through Validation of a Tool to Identify Low Risk STEMI Patients not Requiring CCU Care

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
William E Downey ◽  
Lara M Cassidy ◽  
Kerstin Liebner ◽  
Robyn Magyar ◽  
Angela D Humphrey ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Risk Score ◽  
New Technologies ◽  
Cost Savings ◽  
Low Risk ◽  
Hospital Death ◽  
Cardiac Care ◽  
Primary Pci ◽  
Risk Patients ◽  
Support Cost

Introduction In the early 1960s, the creation of Cardiac Care Units (CCUs) led to a 50% reduction in the in-hospital mortality of acute myocardial infarction (AMI). Prompt application of closed chest cardiac resuscitation and external defibrillation -- then new technologies -- served to reduce the consequences of the event. Over the ensuing four decades, therapeutic advances in the treatment of AMI (e.g. prompt reperfusion strategies) have favorably altered its natural history, potentially obviating the need for CCU care. Since such care is expensive, identification of a low risk cohort of patients in whom this care is not necessary could allow substantial improvements in the cost of cardiac care. Hypothesis Existing risk models can be used to accurately identify low risk STEMI patients who do not require CCU care after primary PCI. Methods We performed a retrospective chart review of all STEMI cases from 2010 at Carolinas Medical Center. We then assessed them using the TIMI STEMI risk score and a risk assessment algorithm for uncomplicated STEMI developed at Brigham and Women's Hospital (BWH). The BWH STEMI Care Redesign defines low risk STEMI patients as those who are promptly revascularized via successful single vessel PCI with (1) no evidence of ongoing ischemia, (2) EF>40%, (3) absence of CHF, hemodynamic or electrical instability, and (4) who are awake without need of respiratory support. Cost data (fixed and variable) from Quality Advisor™, a product by Premier, was abstracted for each STEMI case, examining specific resources used in CCU and non-CCU units. Results Among 310 consecutive STEMI patients, in-hospital mortality was 3.9%. The BWH risk score identified 46.4% of these patients as low-risk. Among these patients, in-hospital mortality was 0%. Only one of these 144 low-risk patients required subsequent CCU care. None required CPR or defibrillation after revascularization. The TIMI STEMI risk score <2 classified 26.1% of the patients as low-risk. Among these patients, in-hospital mortality was 0%. However, 3.7% of these "low-risk" patients had ventricular arrhythmias or respiratory decompensation during or shortly after PCI. None of the 3.7% were classified as "low-risk" by the BWH model. CCU care added $723 in fixed costs and $340 in variable costs per hospital day. Conclusion The BWH model, but not the TIMI STEMI risk score, accurately predicted a sizable cohort of STEMI patients at very low risk of in-hospital death and complications. These patients may be appropriate for admission to non-CCU level care immediately following primary PCI. Doing so would be projected to yield a cost savings of >$1000 per patient.

Incidence and prognostic impact of bleeding and transfusion after coronary surgery in low‐risk patients

Transfusion ◽  
2016 ◽  
Vol 57 (1) ◽  
pp. 178-186 ◽  
Author(s):  
Eeva‐Maija Kinnunen ◽  
Marisa De Feo ◽  
Daniel Reichart ◽  
Tuomas Tauriainen ◽  
Giuseppe Gatti ◽  
...  
Keyword(s):  
Low Risk ◽  
Prognostic Impact ◽  
Coronary Surgery ◽  
Risk Patients

scholarly journals Validation of a New Classification Method of Postoperative Complications in Patients Undergoing Coronary Artery Surgery

2016 ◽  
Vol 30 (2) ◽  
pp. 330-337 ◽  
Author(s):  
Eeva-Maija Kinnunen ◽  
Matti-Aleksi Mosorin ◽  
Andrea Perrotti ◽  
Vito G. Ruggieri ◽  
Peter Svenarud ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Postoperative Complications ◽  
Classification Method ◽  
New Classification ◽  
Coronary Artery Surgery

Validation of the Inhospital Mortality for Pulmonary Embolism Using Claims Data (IMPACT) Prediction Rule within an All-Payer Inpatient Administrative Claims Database

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 747-747
Author(s):  
Craig I Coleman ◽  
Christine G Kohn ◽  
Concetta Crivera ◽  
Jeff Schein ◽  
W Frank Peacock
Keyword(s):  
Pulmonary Embolism ◽  
Hospital Mortality ◽  
Research Funding ◽  
Prediction Rule ◽  
Low Risk ◽  
Administrative Claims ◽  
Claims Database ◽  
Impact Prediction ◽  
Risk Patients ◽  
Equity Ownership

Background: Current guidelines suggest that low risk pulmonary embolism (PE) patients may be managed as outpatients or with an abbreviated hospital stay. There is need for a claims-based prediction rule that payers and hospitals can use to efficiently risk stratify PE patients. The authors recently derived a rule found to have high sensitivity and moderate specificity for predicting in-hospital mortality. Objective: To validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule originally developed in a commercial claims database in an all-payer administrative database restricted to inpatient claims. Methods: This study utilized data from the 2012 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). Adult PE admissions were identified by the presence of an appropriate International Classification of Diseases, ninth edition, Clinical Modification (ICD-9-CM) code either in the primary position or secondary position when accompanied by a primary code for a PE complication. The IMPACT rule, consists of age + 11 weighted comorbidities calculated based upon the maximum of 25 ICD-9-CM diagnosis codes and 25 procedural codes reported for each discharge in the NIS (myocardial infarction, chronic lung disease, stroke, prior major bleeding, atrial fibrillation, cognitive impairment, heart failure, renal failure, liver disease, coagulopathy, cancer), and was used to estimate patients' risk of in-hospital mortality. Low risk was defined as in-hospital mortality ≤1.5%. We present the validity of the rule by calculating prognostic test characteristics and 95% confidence intervals (CIs). In order to estimate the potential cost savings from an early discharge, we calculated the difference in total hospital costs between low-risk patients having and not having an abbreviated hospital stay (defined as ≤1, ≤2 or ≤3 days). Results: A total of 34,108 admissions for PE were included (46.7% male, mean ± standard deviation age of 61.9±17.2); and we observed a 3.4% in-hospital PE case-fatality rate. The IMPACT prediction rule classified 11,025 (32.3%) patient admissions as low-risk; and had a sensitivity of 92.4% (95%CI=90.7-93.8), specificity of 33.2% (95%CI=32.7-33.7), negative and positive predictive values of 99.2% (95%CI=99.0-99.4) and 4.6% (95%CI=4.4-4.9) and a C-statistic of 0.74 (95%CI=0.73-0.76) for in-hospital mortality. Low-risk patients had significantly lower in-hospital mortality (0.8% vs. 4.6%, odds reduction of 83%; 95%CI=79-87), shorter LOSs (-1.2 days, p<0.001) and lower total treatment costs (-$3,074, p<0.001) than patients classified as higher-risk. Of low-risk patients, 13.1%, 31.1% and 47.7% were discharged within 1, 2 and 3 days of admission. Low-risk patients discharged within 1 day accrued $5,465 (95%CI=$5,018-$5,911) less in treatment costs than those staying longer. Discharge within 2 or 3 days in low-risk patients was also associated with a reduced cost of hospital treatment [$5,820 (95%CI=$5,506-$6,133) and $6,314 (95%CI=$6,031-$6,597), respectively] when compared to those staying longer. Conclusion: The prior claims-based in-hospital mortality prediction rule was valid when used in this all-payer, inpatient only administrative claims database. The rule classified patients' mortality risk with high sensitivity and had a high negative predictive value; and consequently, may be valuable to those wishing to benchmark rates of PE treated at home or following an abbreviated hospital admission. Disclosures Coleman: Janssen Scientific Affairs, LLC: Consultancy, Research Funding. Crivera:Janssen Scientific Affairs, LLC: Employment, Equity Ownership. Schein:Janssen Scientific Affairs, LLC: Employment. Peacock:Singulex: Consultancy; Prevencio: Consultancy; The Medicines Company: Consultancy, Research Funding; Roche: Consultancy, Research Funding; Portola: Consultancy, Research Funding; Janssen Pharmaceuticals: Consultancy, Research Funding; Cardiorentis: Research Funding; Banyan: Research Funding; Alere: Research Funding; Abbott: Research Funding; Comprehensive Research Associates, LLC: Equity Ownership; Emergencies in Medicine, LLC: Equity Ownership.

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